Transcription of APPENDIX A.2 FAMILY MEDICAID 2017 (effective …
1 VOLUME II/MA, MT 51 04/ 2017 APPENDIX A2 (04/ 2017 ) APPENDIX FAMILY MEDICAID 2017 ( effective 04/01/ 2017 ) 2017 INCOME LIMITS Percentage of the Federal Poverty Level (FPL) FAMILY Size Parent/ Caretaker with Children Plus 5% 247% PeachCare for Kids Plus 5% 220% PGW Newborn Plus 5% 205% Child 0-1 TMA Plus 5% 200% WHM P4HB Plus 5% 149% Child 1-5 Plus 5% 133% Child 6-19 Plus 5% FAMILY MEDICAID MNIL 1 $310 361 2483 2533 2211 2262 2061 2112 2010 2061 1498 1549 1337 1388 208 2 457 525 3343 3411 2978 3046 2775 2843 2707 2775 2017 2085 1800 1868 317 3 551 637 4204 4490 3744 3830 3489 3575 3404 3490 2536 2622 2264 2350 375 4 653 756 5064 5149 4510 4613 4203 4306 4100 4203 3055 3158 2727 2830 442 5 752 872 5924 6044 5277 5397 4917 5037 4797 4917 3574 3694 3190 3310 508 6 826 964 6785 6923 6043 6181 5631 5769 5494 5632 4093 4231 3654 3792 550 7 903 1058 7645 7800 6809 6964 6345 6500 6190 6345 4612 4767 4117 4272 600 8 970 1143 8506 8679 7576 7749 7059 7232 6887 7060 5131 5304 4580 4753 633 9 1034 1224 9366 9556 8342 8532 7773 7963 7584 7774 5650 5840 5043 5233 667 10 1113 1320
2 10226 10433 9108 9315 8487 8694 8280 8487 6169 6376 5507 5714 708 11 1194 1419 11087 11312 9875 10100 9202 9427 8977 9202 6688 6913 5970 6195 758 12 1244 1486 11947 12189 10641 10883 9916 10158 9674 9916 7207 7449 6433 6675 808 13 1294 1553 12804 13063 11404 11663 10627 10886 10368 10627 7724 7983 6895 7154 858 14 1344 1620 13661 13937 12176 12452 11338 11614 11062 11338 8241 8517 7357 7633 908 15 1394 1687 14518 14811 12930 13223 12049 12342 11756 12049 8758 9051 7819 8112 958 16 1444 1754 15375 15685 13693 14003 12760 13070 12450 12760 9275 9585 8281 8591 1008 17 1494 1821 16232 16650 14456 14783 13471 13798 13144 13471 9792 10119 8743 9070 1058 18 1544 1888 17089 17433 15219 15563 14182 14526 13838 14182 10309 10653 9205 9549 1108 For each additional member, add: $857 $763 $711 $694 $517 $462 (+) PER ADDITIONAL BG MEMBER 50 NOTE: A Budget Group of One does not exist for Parent/Caretaker with Child(ren) MEDICAID or Pregnant Woman MEDICAID .
3 2017 RESOURCE LIMITS FAMILY MEDICAID MEDICALLY NEEDY (FM-MN) RESOURCE LIMIT NUMBER OF INDIVIDUALS IN FM-MN BG 1 2 3 4 5 6 7 8 9 10 11 12 $ 2000 4000 4100 4200 4300 4400 4500 4600 4700 4800 4900 5000 FM-MN ALLOWABLE MILEAGE REIMBURSEMENT 54 CENTS PER MILE (04/01/17)
